Provider Demographics
NPI:1629504980
Name:LYONS, INNA N (MSW,SWP)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:N
Last Name:LYONS
Suffix:
Gender:F
Credentials:MSW,SWP
Other - Prefix:MS
Other - First Name:INNA
Other - Middle Name:N
Other - Last Name:SOLDATENKOVA/ARTEMOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYCHOLODIST
Mailing Address - Street 1:620 GALLATIN PIKE N
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2866
Mailing Address - Country:US
Mailing Address - Phone:719-251-4172
Mailing Address - Fax:
Practice Address - Street 1:620 GALLATIN PIKE N
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2866
Practice Address - Country:US
Practice Address - Phone:719-251-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children